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Integrative medicine combines aspects of conventional medicine with alternative medicine for disease treatment or prevention. Although laser therapy, acupuncture, rehabilitation, etc. are still sometimes considered “alternative medicine”, I prefer the term complementary medicine because these approaches are becoming more common and have a continually growing amount of evidence ba sed support. Additionally, the term “alternative” implies “instead of” and I believe that these methods usually work best in conjunction with other, more conventional therapies rather than used in place of these. Physical rehabilitation in particular is a rapidly growing area of veterinary medicine and can be applied to improve the overall wellness of most any animal, regardless of age and medical status.

Physical rehabilitation is synonymous to physical therapy in the human world and uses many methods to help reduce pain, improve function, and balance the overall animal. In my practice, I do not generally prescribe drugs or use traditional medical approaches, but rather work with your family veterinarian to develop a well-rounded treatment plan for your pet. With this approach, we can often improve pain levels and strength enough to eventually decrease the dose or frequency needed for pain medications. This can be especially important for animals with concurrent disease for which some pain medications are contraindicated or higher risk.

Some of the most commonly used integrative therapies in the field of physical rehabilitation are:

My general approach to integrating a physical rehabilitation plan into an animal’s life is to first perform an evaluation of the animal to determine their functional status and establish some goals with the owner. This evaluation is similar to the wellness exam given by your regular veterinarian, but focuses more on identifying musculoskeletal and/or neurologic abnormalities and functional challenges. It is, however, very important to have regular wellness exams performed by your family veterinarian to rule out diseases which can often look like musculoskeletal problems to the untrained eye. For example, dogs with hypothyroidism may show signs of lethargy and weight gain, which can often be mistaken simply as “old age” or inactivity due to arthritis, etc. It is very important to have any concurrent diseases diagnosed and controlled prior to beginning a rehabilitation program in order to have the best outcome.

Another important part of the evaluation is to discuss and establish goals for the patient. The owner’s abilities and needs are one of the most important factors to take into consideration when setting goals. Sometimes these goals are based on needs from a functional standpoint, such as an owner who needs their pet to be able to go up and down stairs to get outside or to a bedroom. Other common goals are simply to help control pain, improve quality of life, and improve mobility.

The last part of the evaluation is to work with the owner to form a treatment plan to include both treatments performed by me as well as a home exercise plan for the owners to do on a daily basis. This plan is very unique to each situation and takes into consideration not only the findings from our exam and the animal’s needs, but also the needs and abilities of the owner. For example, our plan will be very different for pet owners with time restrictions or physical disabilities, than for those who are able to contribute more time to a home program.

Starting with next week’s post, we will start to explore some of the available treatment options and take a look at how these options can be integrated into your pet’s current treatment plan and how they work.

Many folks have been interested in my recent hip surgery, particularly those with animals having an injury for which they are trying to decide whether or not to pursue surgery. Obviously, many injuries and illnesses require immediate surgery, such as certain fractures, foreign body ingestion, etc., but how do you decide what to do when the injury or illness is not life threatening or does not require immediate attention? I learned so much through my own experience that I thought it would be useful to share for my clients going through the decision making process for their pets.

First, a little background. When I was a second year veterinary student, 23 years old, I began having hip pain for no apparent reason which was intermittent and only mildly annoying. I thought it was a reoccurring groin injury from all the time I spent playing outside and it didn’t really interfere with my life much so it was easy enough to ignore. Over the years the pain became more and more frequent as well as more severe and finally, about 3 years ago I was inappropriately “adjusted” in a yoga class and everything went downhill from there. After months of constant pain and waiting for it to heal, I started pursuing options for treatment, still assuming it was a groin injury. With the help of my fantastic chiropractor, Dr. Lou Cavallo (http://cavallochiropractic.com), I was able to better manage my pain and stay more active, but we both became increasingly concerned when the pain kept returning no matter what I did. Eventually, at his suggestion, I got xrays which were unremarkable and then pursued a consult with an orthopedic doctor, which eventually led to a definitive diagnosis of a torn labrum via MRI. After much research, consulting with several surgeons and physical therapists, and severely altering my activity level, I decided surgery was unavoidable if I wanted to return to my normal activities. So, how did I come to this decision 7 years after the fact?

Quality of Life

Quality of life discussions between pet owners and veterinarians are a daily occurrence. For me, this was the single most important factor in making this decision, and I believe this to be true when making decisions for our pets as well.

If the injury had stayed only annoying and mildly painful like in those first several years, I would have never considered surgery. However, by the time I did decide on surgery, I had pretty much given up most of my favorite activities: running, rock climbing, yoga, and hikes had become progressively shorter and less frequent due to the anticipated pain afterwards. Additionally, my job had become increasingly difficult and uncomfortable to the point that I sometimes had to cancel appointments because of the level of pain I was experiencing.

This is the sort of thing that we need to consider with our pets as well: is the mass benign and not in a location where the patient is bothered by it? Or is it in a high motion area, interfering with movement? What is the level of instability and pain in the injured joint and what kind of activities does the patient love or need to do? Although pain levels are very important, it is also important to consider functionality, mobility, and the pet’s ability to cope with any dysfunction that may occur, as well as the owner’s ability to meet the needs of their pet, particularly when exercise and lifestyle needs to be altered significantly.

The Surgeon

For me, the second most important factor in this decision was finding a surgeon with whom I felt comfortable. I did not like the first two surgeons I met with for various reasons. The last one I met with was patient with answering my questions, and was more interested in having me try a steroid injection (the one thing I had not yet tried), prior to pursuing surgery than he was in pushing surgery. Clients often say to me “well of course they’re going to want to do surgery, that’s all a surgeon wants to do!” I truly believe that if you feel this way about your surgeon, you should find a new surgeon. While it is generally true that surgeons like to do surgery, they are also trained to assess and recognize whether a patient is a good surgical candidate, or if that particular condition may improve or remain manageable without surgery. They are experts in their field and thus, should be able to answer your questions and explain their reasoning to you. If the surgeon is not helping you to understand WHY they are making certain recommendations, whether it be surgery or not, then you should talk to someone else. As advocates for our pets, it is imperative that we understand what we are getting into when making this type of decision. Part of your veterinarian’s job, specialist or GP, is to help you make the most informed decision possible for your animals.

Other factors I feel are important in the decision making process include the age of the animal, lifestyle and circumstances of the animal and owner, and any concurrent health issues. For me, I was relatively young and otherwise healthy. My geriatric dog had passed away, so I had less demands at home and would be able to devote myself entirely to proper healing, which for orthopedic surgeries is more time consuming than one may realize! As a pet owner, you also need to consider these factors during the decision making process: What is the expected healing time and aftercare? What else is going on in your life that may interfere? How prepared are you to properly manage the pet during the post-operative period (whether it be exercise restriction, wound care, etc)?

Surgery is a stressful prospect with inherent risks regardless of the animal or condition being treated. There is always the possibility of complications and/or failure. Being thoroughly informed, asking questions and having discussions with the veterinarian prior to surgery is SO important to both lower the risks, and to decrease stress surrounding the decision making process and the procedure. As always, contact me with any questions!